exam 4
What is the normal rate for the SA node when the patient is at rest?
a. 40 to 60 beats per minute b. 60 to 100 beats per minute c. 20 to 40 beats per minute d. More than 100 beats per minute ANS: B
The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P wave and 20 small boxes between each R wave. What is the ventricular rate?
a. 50 beats/min b. 75 beats/min c. 85 beats/min d. 100 beats/min ANS: B
The patient is admitted with a condition that requires cardiac rhythm monitoring. To apply the monitoring electrodes, the nurse must first take what action?
a. Apply a moist gel to the chest. b. Make certain that the electrode gel is dry. c. Avoid soaps to avoid skin irritation. d. Clip chest hair if needed. ANS: D
The normal width of the QRS complex is which of the following? (Select all that apply.)
a. 0.06 to 0.10 seconds. b. 0.12 to 0.20 seconds. c. 1.5 to 2.5 small boxes. d. 3.0 to 5.0 small boxes. e. 0.04 seconds or greater. ANS: A, C
The nurse is reading the cardiac monitor and notes that the patient's heart rhythm is extremely irregular and there are no discernible P waves. The ventricular rate is 90 beats per minute, and the patient is hemodynamically stable. The nurse realizes that the patient is demonstrating what rhythm?
a. Atrial fibrillation b. Atrial flutter c. Atrial flutter with rapid ventricular response d. Junctional escape rhythm ANS: A
The patient's heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds. The heart rate is 54 beats per minute. The nurse recognizes the rhythm as a junctional escape rhythm, and understands that the rhythm is due to what cause?
a. Loss of sinus node activity b. Increased rate of the AV node c. Increased rate of the SA node d. Decreased rate of the AV node ANS: A
The patient is admitted with a fever and rapid heart rate and a temperature of 103 F (39.4 C).The nurse places the patient on a cardiac monitor and finds the patient's atrial and ventricular rates are above 105 beats per minute. P waves are clearly seen and appear normal in configuration. QRS complexes are normal in appearance and 0.08 seconds wide. The rhythm is regular, and blood pressure is normal. What should be the nurse's initial focus?
a. Medications to lower heart rate b. Treatment to lower temperature c. Treatment to lower cardiac output d. Treatment to reduce heart rate ANS: B
The nurse is caring for a patient diagnosed with atrial fibrillation. Sequelae that place the patient at greater risk for mortality/morbidity include which of the following? (Select all that apply.)
a. Stroke b. Ashman beats c. Pulmonary emboli d. Prolonged PR interval e. Decreased cardiac output ANS: A, C, E
The patient has a permanent pacemaker inserted. The provider has set the pacemaker to the demand mode at a rate of 60 beats per minute. How does the nurse interpret this?
a. The pacemaker will pace only if the patient's intrinsic heart rate is less than 60beats per minute. b. The demand mode often competes with the patient's own rhythm. c. The demand mode places the patient at risk for the R-on-T phenomenon. d. The fixed rate mode is safer and is the mode of choice. A
The patient is in third-degree heart block (complete heart block) and is symptomatic. The treatment for this patient is which of the following? (Select all that apply.)
a. Transcutaneous pacemaker b. Atropine IV c. Temporary transvenous pacemaker d. Permanent pacemaker e. Amiodarone IV ANS: A, C, D
The nurse notices ventricular tachycardia on the heart monitor. When the patient is assessed, the patient is found to be unresponsive with no pulse. The nurse should take what action immediately
a. Treat with intravenous amiodarone or lidocaine. b. Begin cardiopulmonary resuscitation and advanced life support. c. Provide electrical cardioversion. d. Ignore the rhythm since it is benign. ANS: B
Why is the sinus node identified as the pacemaker of the heart?
a.It contains the fastest pacemaker cell in the heart. b.It has the only pacemaker cell in the heart. c.It contains the only cell that does not affect the cardiac cycle. d.It is located in the left side of the heart. ANS: A
The QT interval is the total time taken for ventricular depolarization and repolarization. Prolongation of the QT interval will result in what outcome?
. Decreased risk of lethal dysrhythmias b. Increase in heart rate c. Increase in the risk of lethal dysrhythmias. d. Will only be measured with irregular rhythms. ANS: C
. The nurse is preparing to obtain a pulmonary artery occlusion pressure (PAOP) reading for a patient who is mechanically ventilated. Ensuring that the air-fluid interface is at the level of the phlebostatic axis, what is the best nursing action?
. a. Place the patient in the supine position and record the PAOP immediately after exhalation. b. Place the patient in the supine position and document the average PAOP obtained after three measurements. c. Place the patient with the head of bed elevated 30 degrees and document the average PAOP pressure obtained. d. Place the patient with the head of bed elevated 30 degrees and record the PAOP just before the increase in pressures during inhalation. ANS: D Pressures are h
Electrocardiogram (ECG) paper contains a standardized grid where the horizontal axis measures time and the vertical axis measures voltage or amplitude. The nurse must understand that each horizontal box indicates what?
a. 200 milliseconds or 0.20 seconds duration b. 40 milliseconds or 0.04 seconds duration c. 3 seconds duration d. Millivolts of amplitude ANS: B
The nurse is examining the patient's cardiac rhythm strip in lead II and notices that all of the P waves are upright and look the same except one that has a different shape and is inverted. The nurse realizes that the P wave with the abnormal shape is probably a result of what
a. Originating from the SA node since all P waves come from the SA node. b. Originating from some area in the atria other than the SA node. c. Ventricular depolarization. d. Normal firing even though it is inverted in lead II. ANS: B
What is one of the functions of the atrioventricular (AV) node?
a. Pacing the heart if the ventricles fail b. Slowing the impulse arriving from the SA node c. Sending the impulse to the SA node d. Allowing for ventricular filling during systole ANS:B
The patient scheduled to have a permanent pacemaker implanted asks the nurse, "How long will the battery in this thing last?" What answer should the nurse provide?
a. "Life expectancy is about 1 year. Then it will need to be replaced." b. "Pacemaker batteries can last up to 25 years with constant use." c. "Battery life varies depending on usage, but it can last up to 10 years." d. "Pacemakers are used to treat temporary problems so the batteries don't last long." ANS: C
The nurse is educating a patient's family member about a pulmonary artery catheter (PAC). Which statement by the family member best indicates understanding of the purpose of the PAC
a. "The catheter will provide multiple sites to give intravenous fluid." b. "The catheter will allow the primary health care provider to better manage fluid therapy." c. "The catheter tip comes to rest inside my brother's pulmonary artery." d. "The catheter will be in position until the heart has a chance to heal." ANS: B
The patient's heart rate is 70 beats per minute with the P waves coming after the QRS complex. The nurse correctly determines that the patient is demonstrating what heart rhythm?
a. A normal junctional rhythm b. An accelerated junctional rhythm c. A junctional tachycardia d. Atrial fibrillation ANS: B
The charge nurse is supervising the care of four critical care patients being monitored using invasive hemodynamic modalities. Which patient should the charge nurse evaluate first?
a. A patient in cardiogenic shock with a cardiac output (CO) of 2.0 L/min b. A patient with a pulmonary artery systolic pressure (PAP) of 20 mm Hg c. A hypovolemic patient with a central venous pressure (CVP) of 6 mm Hg d. A patient with a pulmonary artery occlusion pressure (PAOP) of 10 mm Hg ANS: A
The charge nurse is supervising care for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the charge nurse evaluate first?
a. A patient with a central venous pressure (RAP/CVP) of 6 mm Hg and 40 mL of urine output in the past hour b. A patient with a left radial arterial line with a BP of 110/60 mm Hg and slightly dampened arterial waveform c. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula d. A patient with a pulmonary artery pressure of 25/10 mm Hg and an oxygen saturation of 94% on 2 L of oxygen via nasal cannula ANS: C
The patient's heart rate is 165 beats per minute and the cardiac monitor shows a rapid rate with narrow QRS complexes. The P waves cannot be seen, but the rhythm is regular. The patient's blood pressure has dropped from 124/62 to 78/30; skin is cold and diaphoretic and the patient is reporting nausea. The nurse prepares the patient for what intervention?
a. Administration of beta-blockers b. Administration of atropine c. Transcutaneous pacemaker insertion d. Emergent cardioversion ANS: D
The nurse is preparing for insertion of a pulmonary artery catheter (PAC). During insertion of the catheter, what are the priority nursing actions? (Select all that apply.)
a. Allay the patient's anxiety by providing information about the procedure. b. Ensure that a sterile field is maintained during the insertion procedure. c. Inflate the balloon during the procedure when indicated by the physician. d. Monitor the patient's cardiac rhythm throughout the entire procedure. e. Obtain informed consent by informing the patient of procedural risks. ANS: A, B, C, D
The nursing is caring for a patient who has had an arterial line inserted. To reduce the risk of complications, what is the priority nursing intervention?
a. Apply a pressure dressing to the insertion site. b. Ensure all tubing connections are tightened. c. Obtain a portable x-ray to confirm placement. d. Restrain the affected extremity for 24 hours.
The nurse is caring for a 70-kg patient in septic shock with a pulmonary artery catheter. Which hemodynamic value indicates an appropriate response to therapy aimed at enhancing oxygen delivery to the organs and tissues?
a. Arterial lactate level of 1.0 mEq/L b. Cardiac output of 2.5 L/min c. Mixed venous (SvO2) of 40% d. Cardiac index of 1.5 L/min/m2 ANS: A
The patient is in chronic junctional escape rhythm with no atrial activity noted. Studies have demonstrated normal AV node function. This patient may be a candidate for which type of pacing
a. Atrial pacing b. Ventricular pacing c. Dual-chamber pacing d. Transcutaneous pacing ANS: A
A patient is admitted to the hospital with multiple trauma and extensive blood loss. The nurse assesses vital signs to be BP 80/50 mm Hg, heart rate 135 beats/min, respirations 36 breaths/min, cardiac output (CO) of 2 L/min, systemic vascular resistance of 3000 dynes/sec/cm5 , and a hematocrit of 20%. The nurse anticipates administration of which the following therapies or medications?
a. Blood transfusion b. Furosemide c. Dobutamine infusion d. Dopamine hydrochloride infusion ANS: A
Sinus bradycardia is a symptom of which of the following? (Select all that apply.)
a. Calcium channel blocker medication b. Beta-blocker medication c. Athletic conditioning d. Hypothermia e. Hyperthyroidism ANS: A, B, C, D
The nurse is caring for a 100-kg patient being monitored with a pulmonary artery catheter. The nurse assesses a blood pressure of 90/60 mm Hg, heart rate 110 beats/min, respirations 36/min, oxygen saturation of 89% on 3 L of oxygen via nasal cannula. Bilateral crackles are audible upon auscultation. Which hemodynamic value requires immediate action by the nurse?
a. Cardiac index (CI) of 1.2 L/min/m3 b. Cardiac output (CO) of 4 L/min c. Pulmonary vascular resistance (PVR) of 80 dynes/sec/cm5 d. Systemic vascular resistance (SVR) of 1800 dynes/sec/cm5 ANS: A
Upon entering the room of a patient with a right radial arterial line, the nurse assesses the waveform to be slightly dampened and notices blood to be backed up into the pressure tubing. What is the best action by the nurse?
a. Check the inflation volume of the flush system pressure bag. b. Disconnect the flush system from the arterial line catheter. c. Zero reference the transducer system at the phlebostatic axis. d. Reduce the number of stopcocks in the flush system tubing. ANS: A
. The nurse is preparing to obtain a right atrial pressure (RAP/CVP) reading. What are the most appropriate nursing actions? (Select all that apply.)
a. Compare measured pressures with other physiological parameters. b. Flush the central venous catheter with 20 mL of sterile saline. c. Inflate the balloon with 3 mL of air and record the pressure tracing. d. Obtain the right atrial pressure measurement during end exhalation. e. Zero reference the transducer system at the level of the phlebostatic axis. ANS: A, D, E
The nurse is talking with the patient when the monitor alarms and shows a wavy baseline without a PQRST complex. The nurse should take what action immediately?
a. Defibrillate the patient immediately. b. Initiate basic life support. c. Initiate advanced life support. d. Assess the patient and the electrical leads. ANS: D
While caring for a patient with a small bowel obstruction, the nurse assesses a pulmonary artery occlusion pressure (PAOP) of 1 mm Hg and hourly urine output of 5 mL. The nurse anticipates which therapeutic intervention?
a. Diuretics b. Intravenous fluids c. Negative inotropic agents d. Vasopressors ANS: B
The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hemodynamic monitoring measurements, what is the best nursing action?
a. Do not document hemodynamic values until the patient can be placed in the supine position. b. Level and zero reference the air-fluid interface of the transducer with the patient in the supine position and record hemodynamic values. c. Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values. d. Level and zero reference the air-fluid interface of the transducer with the patient supine in the side-lying position and record hemodynamic values. ANS: C
The nurse returns from the cardiac catheterization laboratory with a patient following insertion of a pulmonary artery catheter and assists in transferring the patient from the stretcher to the bed. Prior to obtaining a cardiac output, which action is most important for the nurse to complete
a. Document a pulmonary artery catheter occlusion pressure. b. Zero reference the transducer system at the phlebostatic axis. c. Inflate the pulmonary artery catheter balloon with 1 mL air. d. Inject 10 mL of 0.9% normal saline into the proximal port. ANS: B
The nurse understands what to be true of a third-degree AV block?
a. Every P wave is conducted to the ventricles b. Some P waves are conducted to the ventricles c. None of the P waves are conducted to the ventricles d. The PR interval is prolonged ANS: C
The nurse working on the night shift when notices sinus bradycardia on the patient's cardiac monitor. What initial action should the nurse take?
a. Give atropine to increase heart rate. b. Begin transcutaneous pacing of the patient. c. Start a dopamine infusion to stimulate heart function. d. Assess for hemodynamic instability. ANS: D
Which of the following are common causes of sinus tachycardia? (Select all that apply.)
a. Hyperthyroidism b. Hypovolemia c. Hypothyroidism d. Heart Failure e. Sleep ANS: A, B, D
While caring for a patient with a pulmonary artery catheter, the nurse notes the pulmonary artery occlusion pressure (PAOP) to be significantly higher than previously recorded values. The nurse assesses respirations to be unlabored at 16 breaths/min, oxygen saturation of 98% on 3 L of oxygen via nasal cannula, and lungs clear to auscultation bilaterally. What is the priority nursing action?
a. Increase supplemental oxygen and notify respiratory therapy. b. Notify the physician immediately of the assessment findings. c. Obtain a stat chest x-ray film to verify proper catheter placement. d. Zero reference and level the catheter at the phlebostatic axis. ANS: D
When performing an initial pulmonary artery occlusion pressure (PAOP), what are the best nursing actions? (Select all that apply.)
a. Inflate the balloon for no more than 8 to 10 seconds while noting the waveform change. b. Inflate the balloon with air, recording the volume necessary to obtain a reading. c. Maintain the balloon in the inflated position for 8 hours following insertion. d. Zero reference and level the air-fluid interface of the transducer at the level of the phlebostatic axis. e. Inflate and deflate the balloon on an hourly schedule ANS: A, B, D
Because of the location of the AV node, the possible P waveforms that are associated with junctional rhythms include which of the following? (Select all that apply.)
a. No P wave b. Inverted P wave c. Shortened PR interval d. P wave after the QRS complex e. Normal P wave and PR interval ANS: A, B, C, D
The rhythm on the cardiac monitor is showing numerous pacemaker spikes, but no P waves or QRS complexes following the spikes. The nurse realizes this as what?
a. Normal pacemaker function b. Failure to capture c. Failure to pace d. Failure to sense ANS: B
The patient has a permanent pacemaker in place with a demand rate set at 60 beats/min. The cardiac monitor is showing a heart rate of 44 beats/min with no pacemaker spikes. How does the nurse interpret this?
a. Normal pacemaker function b. Failure to capture c. Failure to pace d. Failure to sense ANS: C
. The nurse notices that a patient is in first-degree AV block but everything else about the rhythm is normal. The nurse should be prepared to take what action?
a. Placing the patient on a transcutaneous pacemaker. b. Giving the patient atropine to shorten the PR interval. c. Monitor the rhythm and patient's condition. d. Giving the patient an antiarrhythmic medication. ANS: C
The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I. The patient is on digitalis medication at home. The nurse should expect that action to be taken?
a. The patient has had an anterior wall myocardial infarction. b. The physician will order the digitalis to be continued in the hospital. c. A digitalis level would be ordered upon admission. d. The patient will require a transcutaneous pacemaker. ANS: C
The patient is having premature ventricular contractions (PVCs). What is the nurse's greatest concern?
a. The proximity of the R wave of the PVC to the T wave of a normal beat. b. The fact that PVCs are occurring, because they are so rare. c. If the number of PVCs are decreasing. d. If the PVCs are wider than 0.12 seconds. ANS: A
The nurse is caring for a patient with a pulmonary artery catheter. Assessment findings include a blood pressure of 85/40 mm Hg, heart rate of 125 beats/min, respiratory rate 35 breaths/min, and arterial oxygen saturation (SpO2) of 90% on a 50% venturi mask. Hemodynamic values include a cardiac output (CO) of 1.0 L/min, central venous pressure (CVP) of 1 mm Hg, and a pulmonary artery occlusion pressure (PAOP) of 3 mm Hg. The nurse questions which of the following primary health care provider's order?
a. Titrate supplemental oxygen to achieve a SpO2 > 94%. b. Infuse 500 mL 0.9% normal saline over 1 hour. c. Obtain arterial blood gas and serum electrolytes. d. Administer furosemide 20 mg intravenously. ANS: D
